Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización

Fernández, Constantino; Calvo, María Victoria Martínez; Leite, N.; López, A.; Ferreiro, Tamara; Ribera, R. Porta; Seijo, Rocío; Alonso, Ángel

doi:10.1016/j.nefro.2017.06.006

Cited by 13 publications

(3 citation statements)

References 22 publications

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“…When no compatible living donor is available, but there is a willingness to donate, the condition of the donorspecific anti-HLA antibodies present in the recipient should be assessed and options of HLA desensitisation or paired/pooled donation kidney transplantation should be considered, the latter being the preferable option. 20 It is important to stress that paired/pooled donation and HLA desensitisation or ABO matching are complementary rather than competing initiatives, as most recipients included in paired/pooled donation kidney transplant programmes have few transplant options after being on the waiting list for more than a year, or not having found an option in four matching runs. 21 The best results in LDKT with HLA or ABO incompatibility combine apheresis techniques with CD20 antibodies, polyclonal immunoglobulin and triple immunosuppression.…”

Section: Donation and Transplant Techniquesmentioning

confidence: 99%

Living-donor kidney transplant: guidelines with updated evidence

Frutos

Crespo

Valentín

et al. 2022

Nefrología (English Edition)

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Section: Donation and Transplant Techniquesmentioning

confidence: 99%

Living-donor kidney transplant: guidelines with updated evidence

Frutos

Crespo

Valentín

et al. 2022

Nefrología (English Edition)

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“…The incidence of AR varies from 0 to 60% in different series [20,21], although in recent years it has usually been between 15 and 30% [7,9,12,13,22]. Little is known about the mechanisms behind these numbers and regarding AR's good response to treatment, which allows graft survival rates of 90% at five years.…”

Section: Discussionmentioning

confidence: 99%

Low Incidence of Acute Antibody-Mediated Rejection after HLA Desensitization in Living Donor Kidney Transplant Recipients

Fernández

Magariños

Rodríguez

et al. 2022

Life

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Desensitization allows the performance of human leukocyte antigen (HLA)-incompatible transplants. However, the incidence of acute rejection (AR) is high. This study aims to analyze the incidence of AR after transplantation with HLA-incompatible living donors in patients who underwent desensitization. Patients were immunosuppressed with tacrolimus, mycophenolic acid derivatives, and steroids after being desensitized with rituximab, plasma exchange, and/or immunoadsorption with specific cytomegalovirus immunoglobulins. A negative complement-dependent cytotoxicity or flow cytometry crossmatch and a donor-specific antibody titer < 1000 mean fluorescence intensity (MFI) were used to determine desensitization efficacy. A total of 36 patients underwent desensitization, and 27 (75%) were transplanted. After a follow-up of 58 ± 58 months (Min–Max: 0.13–169.5), five episodes of AR occurred: two antibody-mediated and three T-cell-mediated. No differences were found in baseline calculated panel-reactive antibodies (cPRA), class I or II MFI, number of antibodies, or Relative Intensity Scale (RIS) between AR and non-AR patients. Patients with antibody-mediated AR had higher cPRA (NS), MFI class I (p = 0.07) and class II (p = 0.006), and RIS (p = 0.01). The two patients with antibody-mediated AR and one patient with T-cell-mediated AR lost their grafts. In conclusion, the incidence of acute antibody-mediated rejection after desensitization was 7.4%, which occurred early post-transplantation in patients with high MFI and was associated with early graft loss.

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“…La introducción de diferentes técnicas de aféresis ha permitido realizar trasplantes renales de donante vivo con incompatibilidad del grupo sanguíneo de forma segura y con una supervivencia del injerto comparable a los TR del mismo grupo. También ha permitido realizar el tratamiento del rechazo mediado por anticuerpos que puede limitar en gran medida la supervivencia del injerto 3,4 .…”

Section: Introductionunclassified

Resultados de la inmnuadsorción en el trasplante ABOi y el rechazo humoral en una unidad de hemodiáilsis hospitalaria

et al. 2018

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INTRODUCCIÓN El tratamiento con inmunoadsorción no selectiva fue introducido en nuestra unidad de hemodiálisis hospitalaria con el objetivo de permitir la desensibilización previa a un trasplante renal con incompatibilidad de grupo sanguíneo y el tratamiento del rechazo mediado por anticuerpos. OBJETIVO Analizar los resultados de la técnica de inmunoadsorción no selectiva, en una unidad de hemodiálisis hospitalaria. MATERIAL Y MÉTODOS Estudio retrospectivo, descriptivo, de los primeros 18 pacientes tratados en nuestro centro con inmunoadsorción no selectiva (años 2012-2017) en las indicaciones de acondicionamiento del trasplante ABOi y tratamiento del rechazo humoral. RESULTADOS Durante un periodo de 5 años se analizaron un total de 128 sesiones de inmunoadsorción no selectiva. El 38,9% (n=7) de los casos para desensibilización previa al trasplante renal con incompatibilidad de grupo sanguíneo y el 61,1% (n=11) restante para el tratamiento del rechazo mediado por anticuerpos. En el primer caso, realizaron una media de 8±0,6 sesiones de inmunoadsorción previas al trasplante renal y el 57,1% se complementaron 2 sesiones posteriores. El tratamiento concomitante fue el protocolizado con Rituximab e inmunoglobulinas, requiriendo el 57,1% la realización de recambios plasmáticos. En el segundo caso, realizaron una media de 5,9±2 sesiones de inmunoadsorción. El tratamiento concomitante fue el mismo y el 27,3% realizaron recambios plasmáticos. CONCLUSIONES El trasplante renal de donante vivo ABOi tras la desensibilización fue posible en el 100% de los pacientes. El 72,7% de los pacientes tratados para el rechazo mediado por anticuerpos mantienen actualmente la funcionalidad del injerto.

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Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización

Cited by 13 publications

References 22 publications

Living-donor kidney transplant: guidelines with updated evidence

Living-donor kidney transplant: guidelines with updated evidence

Low Incidence of Acute Antibody-Mediated Rejection after HLA Desensitization in Living Donor Kidney Transplant Recipients

Resultados de la inmnuadsorción en el trasplante ABOi y el rechazo humoral en una unidad de hemodiáilsis hospitalaria

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